It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Diabetes Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 07-25-2008, 09:15 PM   #1
Newbie
(female)
 
Join Date: Jul 2008
Location: Las Vegas, NV
Posts: 4
Molly1999BG HB User
Glucose up at night

I am Type II, and when I go to bed my glucose can be 98, but in the morning it is 198. I am not eating late, or dinking other than water. I don't know why it goes up at night.

 
Old 07-25-2008, 10:02 PM   #2
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

This is called "dawn phenomenon". Your liver makes glucose for your body overnight in response to hormones like growth hormone, and catecholamines.

It is not found as often in type 2 diabetes as in type 1 diabetics. There is also a Somogyi effect which is observed in people who take long-acting insulins. But I am centering on dawn phenomenon because type 2 folks are typically not insulin-dependent.

The occurrence of dawn phenomenon in type 2 diabetes is thought by some to be linked to a person who doesn't produce enough insulin.

You say you don't eat a before-bed snack? You might want to try doing it....seems odd, I know.... but your liver might respond to a little extra sugar level overnight by not producing so much glucose. You might find that your
morning sugar before eating actually is lower if you eat a small snack before retiring to sleep.

Please remember that your diabetic treatment's goal is to lower the time product of blood sugar level in your body, and not necessarily to "smooth" perturbations in it. Your finger-stick meter takes a "snapshot" of your blood sugar level at one point in time. You may experience this "dawn phenomenon" but still have quite adequate control of your diabetes because the long-term effects are governed by the AVERAGE of your sugars over time.

The basic indicator for the treatment effectiveness of your diabetes is the Hemoglobin A1c test. It gives an indication of this "time-averaged" sugar level, mostly of the six-week period preceding the test.

There is a hemoglobin A1c test sold by Wal-Mart for 9 bucks now. You finger-stick and mail it in to the lab. You can get your result by return mail or by email. You want to maintain this Hemoglobin A1c below 7.

 
Sponsors Lightbulb
   
Old 07-26-2008, 03:11 AM   #3
Newbie
(female)
 
Join Date: Jul 2008
Location: Las Vegas, NV
Posts: 4
Molly1999BG HB User
Re: Glucose up at night

Thank you. What is curious to me is most of the time I have good control, but on nights when it is so high in the morning, no matter how careful I am during that day, no mater how much I walk, it is very hard to get down. In a 24 hour period it might drop 40 points. A friend keeps insisting it could be Sleep Apnea causing the high numbers, has anyone heard of this?

 
Old 07-26-2008, 12:17 PM   #4
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

I have not heard of a correlation made between sleep apnea and blood sugars.

I don't know what your drug therapy regimen is. But I want to suggest also that certain types of foods - especially those which are high in fat content - release sugar more slowly than carbohydrates and can cause extended elevations in your sugar.

Drugs such as Metformin (I don't know if you are on it or not but it is a very popular script for type 2) depend on being in it's active part of the half-life in the body at the same time the food is being absorbed. It has a half-life of from 4 to 8.7 hours in the body. So, if you take your met at night, it is gone before your liver unloads its glucose. Your sugar remains high, then, because that's what diabetes is.....and nothing is treating your diabetes at the time when the sugar load is there.

Some drugs, like amaryl, are very quick-acting, being at maximum plasma concentration about 2-3 hours after taking it. It is gone in 6.

 
Old 07-26-2008, 12:37 PM   #5
Newbie
(female)
 
Join Date: Jul 2008
Location: Las Vegas, NV
Posts: 4
Molly1999BG HB User
Re: Glucose up at night

Quote:
Originally Posted by tfkeel View Post
I have not heard of a correlation made between sleep apnea and blood sugars.

I don't know what your drug therapy regimen is. But I want to suggest also that certain types of foods - especially those which are high in fat content - release sugar more slowly than carbohydrates and can cause extended elevations in your sugar.

Drugs such as Metformin (I don't know if you are on it or not but it is a very popular script for type 2) depend on being in it's active part of the half-life in the body at the same time the food is being absorbed. It has a half-life of from 4 to 8.7 hours in the body. So, if you take your met at night, it is gone before your liver unloads its glucose. Your sugar remains high, then, because that's what diabetes is.....and nothing is treating your diabetes at the time when the sugar load is there.

Some drugs, like amaryl, are very quick-acting, being at maximum plasma concentration about 2-3 hours after taking it. It is gone in 6.
That is very interesting and I think helpful. I do take Metformin 500 mg, and Glipizide 10 mg. I am a night person, bed is around 2 AM and up at around 10 AM to noon. I take both meds around 10AM and 10PM, but after taking the morning one, I may not eat "breakfast" for another couple of hours. And at night, the 10PM med, I may not eat again until the next day around 2PM. So.......if I understand correctly that may be the problem. The meds are our of my system before the food is consumed. Do I have this right?

 
Old 07-26-2008, 07:19 PM   #6
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

Yes, I think you do indeed have it right.

I also don't know how long you have been on glipizide. In the beginning of my diabetic journey nearly 20 years ago now, I was on glipizide (Glucotrol) - it worked quite well for me for several years with no other med.

Glipizide has a very short elimination half-life in the body, about 2-4 hours in people with normal metabolism. It reaches peak plasma levels a half-hour to hour after you take it.

Let's say you eat a balanced meal at 2 pm which consists of 1 fat and a couple of carbs and a protein. The peak "output" into your sugar is going to be about an hour to two hours after you eat. To get the best action from your glipizide, then you would take it about a half-hour before your meal. The literature states that the response in a test meal situation was best when patients did this. This pretty much puts the insulin and the food at your tissue barriers at the same time.

If your meal is "fatty" - that will move the peak "output" out to about 3 hours or 4 hours after you eat. So if you have fettucine alfredo for your meal, wait about an hour before you take your glipizide.

Take your met with your glip. It is longer acting, its elimination half-life is about 4 to 8 hours and it probably reaches it's highest plasma levels at about 1-2 hours. So that will put your met "on target" pretty much, too.

Now, for your "dawn" sugar.

Your 10 PM dose of glipizide is "doing you in". Your body is seeing the highest effectiveness of it just before you fall asleep. Because you don't eat at night, your sugar is going low just as you doze off. Your liver takes the cue and works to keep you healthy and fed by using its glucose factory.

The met at night is doing virtually nothing at all for you. There's no food.

I think you should try a small carb snack before bed to see if that helps you
calm your liver's nerves.....you might find your morning sugar actually lower with the snack than without. That is, of course, if it is a small snack.....

I don't know if you eat another meal - if you do, then I would probably start by taking the other doses of drugs then.

The alternative is, and especially if you don't want a bedtime snack, if you wake up for a bathroom run during the night, take your glip and your met then.

If you have only been on glipizide a short time, there is something to look forward to. It is a drug which "ramps up" slowly in the therapy. The best insulin-production from your pancreas in response to glipizide occurs after about 6 months on the drug.

For me, who is 20 years down the road on this, a FBS of 98 is a dream. I can keep low 100s if I am very pedantic about my habits and insulin shots.

 
Old 07-27-2008, 01:13 AM   #7
Member
(female)
 
Join Date: Jul 2008
Location: Georgia
Posts: 58
Frances1952 HB User
Re: Glucose up at night

You have helped me too. I am new and a nightowl too. My level was 132 this morning, so I will try eating a carb snack at night too.

 
Old 07-27-2008, 01:32 AM   #8
Newbie
(female)
 
Join Date: Jul 2008
Location: Las Vegas, NV
Posts: 4
Molly1999BG HB User
Re: Glucose up at night

I have learned more from you than I have from anyone, any book and even any doctor. Thank you so much. I will focus on adjustments and see what happens. Truly, thank you.

 
Old 07-27-2008, 08:45 AM   #9
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

You're quite welcome.... and please remember to work in the average of your morning sugars, and not based on one reading or two. The 14-day average is a good indicator, use the average of your med and food versus the average sugar.

And use your HbA1c test for your overall standard. A HbA1c of 7
should correlate to an average sugar reading of 150 or so. This is
the figure you want to use as your "redline" - you want to maintain that 14-day average sugar below 150.

Don't bother to test the HbA1c more than every 6 weeks, and most recommend a 3-month period. The reading you get is, however, primarily determined by the 6-week period prior to the test.

This information should be given to you by your doctor. However, I found, too, that I have had to "root it out" and ask lots of questions to develop the understanding I needed to control my disease with good results. I went for quite a few years with high sugars which I couldn't get down and the doc would look at me and say "we've got to get this down" and then give me the same prescriptions and "see you in 6 months"....as he was scribbling on my chart and was already in the hallway as he finished the sentence.....

I learned that the drug literature that is distributed in the packaging with most of the drugs tells this information that I have given you. But reading that stuff, for me, was quite a challenge when I started.... it was frustrating and I had to use a dictionary....it was slow going for someone not educated in that field.

That information is abundant now on the internet and can be found quite readily.

Last edited by tfkeel; 07-27-2008 at 09:02 AM.

 
Old 07-27-2008, 10:54 AM   #10
Member
(female)
 
Join Date: Jul 2008
Location: Georgia
Posts: 58
Frances1952 HB User
Re: Glucose up at night

Quote:
Originally Posted by tfkeel View Post
You're quite welcome.... and please remember to work in the average of your morning sugars, and not based on one reading or two. The 14-day average is a good indicator, use the average of your med and food versus the average sugar.

And use your HbA1c test for your overall standard. A HbA1c of 7
should correlate to an average sugar reading of 150 or so. This is
the figure you want to use as your "redline" - you want to maintain that 14-day average sugar below 150.

Don't bother to test the HbA1c more than every 6 weeks, and most recommend a 3-month period. The reading you get is, however, primarily determined by the 6-week period prior to the test.

This information should be given to you by your doctor. However, I found, too, that I have had to "root it out" and ask lots of questions to develop the understanding I needed to control my disease with good results. I went for quite a few years with high sugars which I couldn't get down and the doc would look at me and say "we've got to get this down" and then give me the same prescriptions and "see you in 6 months"....as he was scribbling on my chart and was already in the hallway as he finished the sentence.....

I learned that the drug literature that is distributed in the packaging with most of the drugs tells this information that I have given you. But reading that stuff, for me, was quite a challenge when I started.... it was frustrating and I had to use a dictionary....it was slow going for someone not educated in that field.

That information is abundant now on the internet and can be found quite readily.
What do you mean by a 14 day reading. Is this the morning reading before breakfast. I have had my blood moniter for just a few days. The first reading (in the morning before I eat) was 98, the next day 132, and today 122. My bloodtest from my arm was 110 (before eating) I have read this would be considered pre-diabetes, but my doctor says I have diabetes. I have not started taking the medicine yet, although I am feeling more confortable now.

 
Old 07-27-2008, 11:38 AM   #11
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

So, you have given me the information I need for a 4-day average. This is the sum of the 4 readings, divided by 4. You have a 4-day average of 115.

This is not a bad reading - for a diabetic. It is, at the very least, prediabetic.

Your meter, if it is like mine, has a button that I can simply push to get my 14-day average. Although, if the meter didn't have it, I could just record my readings on a paper for 14 days and compute it myself.

The best indicator would be a regimen, like mine, in which I take 4 readings per day and use all of them for the 14-day average. My meter does this automatically for me, all I have to do is do the "sticks". However, it is expensive and troublesome - and, I am certain that I could manage ok if I only took the fasting readings and the HbA1c. I have insurance coverage for the test strips so I take advantage of it.

So, yes, I would advise you , if you take only one reading per day, to do that when you first awake before eating and use that for your average.
Write down your readings, and your averages.

When you get your HbA1c test, then compare it to the 3 14-day averages you had prior to the test. This will show you how good your meter calibration is and show you how you need to adjust your readings. The goal is to maintain an HbA1c below 7. Your 4-day average is not adequate for the comparison, but

Average Plasma Blood Glucose A1C Result
100 mg/dL 5%
135 mg/dL 6%
170 mg/dL 7%
205 mg/dL 8%
240 mg/dL 9%
275 mg/dL 10%
310 mg/dL 11%
345 mg/dL 12%

This chart shows the equivalents in the two readings. If you use the fasting reading alone for your comparison, my own results tell me that this correlation is that the goal of 7 means a FBS of 150. My number disagrees with the chart because it is not the REAL average of my sugars. My sugars are higher during the day when I have eaten. So what I'm saying is that my fasting reading of 150 means that I have an ACTUAL AVERAGE of 170.

This is why your doc is telling you that you have diabetes. Non-diabetics are
4 and 5 on this chart. You are, by your 4-day average, probably a 6. But this 4-day average is inadequate for the correlation.

As a 20-year diabetic who has advanced into insulin dependence and has lots of symptoms, keeping a 6.3 HbA1c means that I have to be absolutely
religious about my habits and about shooting coverage.

One study I read about placed the correlation factor between HbA1c and the FBS at about .7 - meaning that a 170 real average at the "redline" for diabetes management would mean keeping an FBS of 120. In my own situation, the conversion factor is more like .85 or so...as my HbA1c of 6.3 correlates, in my own personal test, to an fbs of about 120.

Last edited by tfkeel; 07-27-2008 at 11:49 AM.

 
Old 07-27-2008, 12:36 PM   #12
Member
(female)
 
Join Date: Jul 2008
Location: Georgia
Posts: 58
Frances1952 HB User
Re: Glucose up at night

Thank you so much for this info. What kind of indicator do you have?? I bought one with a disc, but I have done the test 3 times in a row and they can be a difference of 20
in the reading?

During the day when I eat, my numbers are around 156 after 2 hours of eating a meal. Lower after eating a small snack.

How do I get a HbA1c test done??

Last edited by Frances1952; 07-27-2008 at 12:56 PM.

 
Old 07-27-2008, 01:25 PM   #13
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

My meter is a "OneTouch Ultra 2" - it is a free upgrade because my "OneTouch Ultra" was getting into the 5 year-old area and I started having trouble with my readings. It would no longer calibrate correctly with
test fluid. The company sent me a whole new meter.

Mine doesn't have a disk, just an internal battery memory. If the battery goes dead, I lose all the info. But my first battery lasted about 4 years. I have had this new meter about 2 years and it still has the original battery.

The accuracy of my meter and measurement is about plus or minus 10 percent or so. So, in your readings of 115 average, I could expect to see just about what you have expressed, a spread of 22 points.

Make sure that you wash your hands with some hand soap and dry them completely before you "stick" - contaminants on your finger can REALLY WRECK your readings - big-time.... the drop of blood is so small that it just doesn't take much residue on your finger to make the sample adulterated.

This is another reason to use the long-term average. Because this also averages out the meter inaccuracy....some readings are higher than actual, some lower than actual....so, in an average of a lot of readings, the accuracy is much better than for individual readings.

The easiest way I know of to get HbA1c test is Wal-Mart. They sell one for 9 bucks. You do a finger stick and deposit it on their card and mail it in. I have never used this because my insurance pays for it with a regular blood draw every 3 months if ordered by my doctor. So I just take that one.

There are also some internet sources for HbA1c tests....but I have never tried them, either.

My local independent testing lab won't do HbA1c unless ordered by a doctor. I personally think this is stupid because they do offer a "health screen" with a conventional draw for 40 bucks with no script. But it doesn't include HbA1c.

Your postprandial reading of 156 tells me your diabetes is yet mild. Mine can be 250-300 two hours after a meal. 156 might be 2 hours after an apple for me.

You said that you are uncomfotable taking drugs. I have been on metformin for 10 years. I have yet to have any side effect from it, and it is QUITE GOOD for my sugars. I know this because over the past couple years, I have had to discontinue it because of surgical proceedures and tests and my sugars get harder to control and I need bigger coverage shots.

Having said that, because I think there's no good reason for you to fear metformin..... I think you could successfully manage your diabetes with diet and exercise alone....at the level of progression your numbers indicate.

If you want to try this, reduce carbohydrates in your diet. And when you eat carbs, eat some of the ones which output sugar more slowly like whole-grain breads. I also find that fruit does not raise my sugar levels like refined sugar or bread does. And pasta, for me, is absolute poison.

A good 40-minute exercise like a walk every day will take 10 points off my sugar average.

Last edited by tfkeel; 07-27-2008 at 01:42 PM.

 
Old 07-27-2008, 03:24 PM   #14
Senior Veteran
(male)
 
Machaon's Avatar
 
Join Date: Feb 2003
Location: Fort Laud
Posts: 3,991
Blog Entries: 22
Machaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB UserMachaon HB User
Re: Glucose up at night

Quote:
Originally Posted by tfkeel View Post
... Make sure that you wash your hands with some hand soap and dry them completely before you "stick" - contaminants on your finger can REALLY WRECK your readings - big-time.... the drop of blood is so small that it just doesn't take much residue on your finger to make the sample adulterated.

...

The easiest way I know of to get HbA1c test is Wal-Mart. They sell one for 9 bucks. You do a finger stick and deposit it on their card and mail it in.
You've provided a whole bunch of useful information with all of your posts. Thanks!

I've been actively battling Insulin Resistance/Pre-Diabetes for about four years, currently controlled through a very strict, low glycemic index/low glycemic load diet alone. However, I've just recently increased the home monitoring of my blood sugar, sometimes taking it up to six+ times in a day to learn more about my reaction to certain foods.

Have you found the accuracy of your blood sugar readings changes depending upon which finger you use, and where on your finger you poke, or does it matter?

Thanks!
__________________
CHF, A-Fib, HBP, Diabetes, Asthma doing great

⇒ Avoid allergic & non-allergic irritants/triggers
⇒ Low calorie ovo-vegetarian diet
⇒ Power walk, weight lifts, pushups
⇒ Coreg 25mg bid

Last edited by Machaon; 07-27-2008 at 03:25 PM.

 
Old 07-28-2008, 05:50 AM   #15
Veteran
(male)
 
Join Date: Oct 2006
Location: Orwigsburg, PA, USA
Posts: 435
tfkeel HB User
Re: Glucose up at night

I have not noticed anything I could correlate to which finger, but I never kept that data, either

Interesting question, though....

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Glucose Levels and A1C debra689 General Health 1 10-15-2008 11:16 AM
fasting glucose in 70s Liz1965 Diabetes 1 09-23-2008 08:04 PM
fasting glucose always runs mid to upper 90's-pre-diabetes or normal for some people? dawnmn Diabetes 11 08-24-2008 07:18 PM
Elevated Glucose (fasting) and Fructosamine; Depressed Post-Prandial Insulin jinxie1 Diabetes 3 11-17-2007 02:41 PM
Advice on Glucose Screening Test walnutsmom Pregnancy 1 03-01-2006 03:04 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Actos
Amaryl
Avandia
Glipizide Glucophage
  Humalog
Lantus
Metformin
Novolog
Potassium




TOP THANKED CONTRIBUTORS



Cora1003 (68), SamQKitty (60), JJ (34), Azurah (17), 92261 (12), rosier (7), Machaon (5), sunshine12 (5), Laura789 (5), ladybud (5)

Site Wide Totals

teteri66 (1180), MSJayhawk (1013), Apollo123 (909), Titchou (856), janewhite1 (823), Gabriel (763), ladybud (755), midwest1 (670), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 04:15 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!